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General NPI Number Information
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NPI Number | 1972809671
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Entity Type | Individual
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Provider Name | ANGELETA TAYLOR MD
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Gender | Female
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 1638 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3424
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Country | US
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Telephone | 910-615-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 3502 BONIFACE CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-2635
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Country | US
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Telephone | 347-645-2879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2011-00239
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 076190
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License Number State | GA
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